Why Are So Many U.S. Women Dying From Pregnancy-Related Issues?

The problem appears to be worsening—and more than half of these deaths are preventable.

Why Are So Many U.S. Women Dying From Pregnancy-Related Issues?

Medically reviewed in October 2021

Updated on October 15, 2021

More than 700 women die each year in the United States from complications that develop during pregnancy or delivery­, according to the Centers for Disease Control and Prevention (CDC). Certain groups are disproportionately affected.

According to a 2019 CDC report looking at data compiled between 2011 and 2015, the overall rate of pregnancy-related deaths among non-Hispanic Black women was 42.8 per 100,000 births; it was 32.5 for American Indian/Alaska Native women. For white women, the rate was just 13.0 per 100,000 births.

The risk also increased with age. The rate of pregnancy-related deaths for women aged 30 to 34 was 15.3 per 100,000 births, climbing to 28.7 for women aged 35 to 37, and 76.5 deaths per 100,000 births for women 40 years and older.

As shocking as these rates sound, they also appear to be rising. A 2016 study published in Obstetrics and Gynecology found that the rate jumped by more than 26 percent from 2000 to 2014. By most measures, the U.S. has the highest maternal mortality rate in the developed world.

What’s more, nearly 60 percent of these deaths could be prevented, according to the CDC. Improved clinical care and patient education—as well as access to better housing and transportation, healthier foods, and weight management strategies—could all lower the risk of maternal mortality in the U.S.

“Most of these deaths are preventable, but we are missing opportunities to identify risk factors prior to pregnancy and there are often delays in recognizing symptoms during pregnancy and postpartum, particularly for Black women,” said Lisa Hollier, MD, past president of the American College of Obstetricians and Gynecologists (ACOG), in a May 2019 press release accompanying guidelines on managing cardiovascular disease (CVD) during pregnancy.

Conditions that can lead to pregnancy-related death
Overall, CVD (which includes heart disease and stroke), is to blame for more than 33 percent of pregnancy-related deaths in the U.S. Other leading causes include infection and severe bleeding. These and other life-threatening conditions include the following:

  • Preeclampsia is a condition that causes high blood pressure and, in some serious cases, organ damage, during pregnancy or up to six weeks after delivery.
  • Amniotic fluid embolism occurs during delivery when amniotic fluid enters the mother’s bloodstream. This can cause an allergic-like reaction, leading to cardiac arrest or excessive bleeding. 
  • Postpartum hemorrhage (PPH) can cause heavy bleeding and a significant drop in blood pressure in the days after giving birth.
  • Blood clots usually strike after delivery and can lead to serious conditions such as stroke, deep vein thrombosis (clots in the veins of the legs or pelvis), or pulmonary embolism, which blocks blood flow to the lungs.
  • Cardiomyopathy is a type of heart failure that may surface during the last month of pregnancy or within five months of giving birth.
  • Sepsis can occur during or after pregnancy. It’s an out-of-control immune response to an infection such as pneumonia, influenza, a urinary tract infection, or other complication related to pregnancy.

Why are rates on the rise?
Many factors play into the maternal mortality crisis, including chronic conditions like heart disease and diabetes, which are also increasing in the U.S. and may lead to pregnancy complications.

Unintended pregnancies, which make up nearly half of U.S. pregnancies, are another factor. Women who do not plan to become pregnant may not seek treatment for their chronic conditions and may be less likely to adhere to prenatal guidelines. Lack of insurance and access to quality health care can also contribute to poor prenatal health.

Evidence also suggests that stereotyping and bias within the healthcare system yield racial and ethnic disparities in health, which may contribute to the rising maternal mortality rate. The interplay of heart disease and maternal mortality may also be exacerbated by the way in which severe heart disease is more common among Black women.

“Black women’s risk of dying from CVD is 3.4 times higher than that of white women,” noted ACOG in its 2019 release. “This disparity is due, in part, to racial bias and overt racism that exists in the provision of health care and in health system processes. The greatest health disparities in the management of CVD for black women usually exist prior to pregnancy when risk factors are not identified.”

Women are susceptible to a variety of well-known risk factors for heart disease that affect everyone, such as poor diet, obesity, and inactivity. Women may also experience additional heart disease risk factors, including diabetes or high blood pressure, during pregnancy.

Rates of high blood pressure in particular are on the rise among pregnant women, according to a report published in the American Heart Association’s journal Hypertension in September 2019. Of the nearly 151 million childbirth-related hospitalizations analyzed from 1970 to 2010, researchers found that almost 1 million women had chronic high blood pressure during pregnancy, with the rate increasing an average of 6 percent each year since 1979. Black women had more than twice the rate of high blood pressure during pregnancy of white women.   

Advanced maternal age and increasing rates of Caesarean sections factor into elevated rates of maternal mortality as well, since they both raise the risk for life-threatening complications. Many women may also fail to recognize certain warning signs that their lives may be in danger after giving birth. While new moms may be coached on how to identify signs of an infant emergency, they may not receive instruction on how to take care of themselves, such as how to distinguish between normal postpartum recovery and worrisome symptoms, like extreme pain.

What’s being done to combat the issue?
Some states are working hard to lower maternal mortality rates. The California Maternal Quality Care Collaborative, for example, provides real-time data to participating hospitals and trains staff on how to handle common problems. The results are promising: The maternal death rate in California declined by 55 percent between 2006, when the organization was founded, and 2013.

Another initiative is the Alliance for Innovation on Maternal Health (AIM), funded in part by ACOG. AIM helps equip health care organizations to reduce maternal morbidity and mortality, according to ACOG. Healthcare systems across the country can voluntarily join the program and receive resources and patient safety information.

Amid rising rates of maternal deaths due to heart disease, ACOG released comprehensive guidance in May 2019 advising that all women be screened for heart disease during pregnancy and after birth. ACOG also recommends that pregnant women with high blood pressure be evaluated by their primary care physician or cardiologist 7 to 10 days after they deliver. Pregnant women with heart disease or other heart problems should see their doctors no later than 14 days after giving birth.

How to protect yourself
Your healthcare provider (HCP) should talk to you about potential problems and their signs during pregnancy. In the meantime, you can be proactive by learning about these conditions as well. Here are some ways to safeguard your health:

Get early and regular prenatal and postpartum care. Regular checkups and care during your pregnancy are crucial for you and your baby. Routine tests during pregnancy may include blood work—which can identify issues such as anemia, infections, and gestational diabetes—and  screenings for heart problems. Your HCP may also evaluate you for signs of postpartum depression.

ACOG recommends you remain in touch with your HCP during the 3 weeks after birth, with a comprehensive postpartum visit no later than 12 weeks after delivery. Depending on your individual needs, your HCP will help you determine how often you need follow-up postpartum appointments.

If cost or access is an issue, every U.S. state has a pregnancy care plan to help you afford medical care during pregnancy. Call 1-800-311-BABY to learn how to reach out to your local Health Department.

Address chronic conditions before becoming pregnant. Getting a handle on things like obesity, high blood pressure, diabetes, and heart disease can help keep you and your baby healthy, during and after pregnancy.

Know your numbers. Learn your normal blood pressure levels both before and during pregnancy so you and your HCP can refer to them in an emergency. 

Adhere to prenatal guidelines. Listen to your HCP and follow recommendations about exercise, eating habits, stress levels, and lifestyle changes.

Reach out to your HCP with any questions, big or small. Make a list of any concerns or queries you have along the way and connect with your provider as often as necessary to get them answered. If something feels off or you have pain that is severe or persistent at any point during or after pregnancy, reach out for help.  

Keep moving. As soon as your HCP gives you the green light after delivery, it’s a good move to resume light physical activity. Walking helps get your body back to its normal function and can help prevent blood clots.

Maternal care is extremely important. Staying educated and keeping tabs on your health throughout your pregnancy will empower you to take charge of your well-being. 

Sources:

Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR). Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. May 10, 2019.  68(18);423–429
MacDorman MF, Declercq E, Cabral H, Morton C. Recent increases in the U.S. maternal mortality rate: disentangling trends from measurement issues. Obstet Gynecol. 2016;128(3):447-455.
American College of Obstetricians and Gynecologists. ACOG Releases Comprehensive Guidance on How to Treat the Leading Cause of U.S. Maternal Deaths: Heart Disease in Pregnancy. May 3, 2019.
Centers for Disease Control and Prevention. Reproductive Health: Unintended Pregnancy. Page last reviewed June 28, 2021.
American College of Obstetricians and Gynecologists. Optimizing Postpartum Care. Committee Opinion. Number 736. May 2018.
American College of Obstetricians and Gynecologists. Racial and Ethnic Disparities in Obstetrics and Gynecology. Committee Opinion. Number 649. December 2015.
Ananth CV, Duzyj CM, Yadava S, Schwebel M, Tita ATN, Joseph KS. Changes in the prevalence of chronic hypertension in pregnancy, united states, 1970 to 2010. Hypertension. 2019;74(5):1089-1095.
American College of Obstetricians and Gynecologists. Pregnancy and Heart Disease. Practice Bulletin. Number 212. May 2019.
U.S. Department of Health and Human Services. Office on Women's Health. Prenatal care and tests. Page last updated January 30, 2019.

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